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Szor and Bourguignon (1999) surveyed 32 patients with pressure ulcers for pain using the McGill Pain Questionnaire They found that 28 (875%) had pain at dressing change and 12 (42%) had continuous pain both at rest and during dressing changes Sadly, only two patients were receiving analgesia It is well recognised that burn patients suffer considerable pain at dressing change (Latarjet, 2002) Nagy (1999) investigated the impact on nurses of having to in ict pain on burn patients during dressing changes She found that the commonest strategy was distancing by the nurse, which had the side effect of the nurses becoming less concerned about controlling pain But if nurses developed a strategy of engaging with the pain, they saw it as a challenge to ensure good pain control Taal et al (1999) undertook a validation study of a pain anxiety scale speci cally for burn patients.

The scale included items such as I nd it impossible to relax when my burns are being treated and I am frightened of the pain during and/or after the treatment They found high levels of reliability and internal consistency and suggest that the scale could be used as a method of assessing therapeutic interventions Senecal (1999) stresses the importance of assessment and that it should include the type of pain and pain intensity Krasner (1995) put forward a model of chronic wound experience that divides wound pain into three types: noncyclical acute wound pain, such as sharp debridement; cyclical acute wound.

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Over the next decades, many chefs and restaurateurs followed her lead, seeking out the best seasonal, locally grown, organically raised food productsA few years later, Larry Forgione picked up the banner of local ingredients and local cuisine in his New York City restaurant An American Place Other chefs quickly followed suit, and soon chefs across the continent made names for themselves and their restaurants at least in part by emphasizing good-quality local ingredients Half a century ago, nearly all the most respected chefs working in the United States and Canada were European-bornToday, the movement begun by the pioneering quality-oriented chefs of the 1970s and 1980s has fostered a great number of creative North American born chefs who are among the most respected in the world The public has bene ted greatly from these efforts.

This often is attractive for enterprises that want resiliency but wish to avoid the complexity of BGP Providers tend not to like this because they are geared to operate with BGP, and coordinating customer routing can be labor-intensive Multihomed to Single Provider with Multiple POPs An increasingly common case, is appropriate to enterprises that connect to the same service provider at multiple geographic POPs This is a reasonable strategy if the enterprise has contracted with a nationallevel provider for facility diversity Quite decent arguments can be made for having BGP connectivity to multiple POPs of the same ISP If, for example, a single ISP is responsible for upstream availability, it can be made responsible for ensuring that its upstream connectivity goes through diverse physical paths Simply assuming that two arbitrarily chosen ISPs will use different upstream providers is a dangerous assumption.

And yet despite these metaphors and promised benefits, the earlier question remains How can we be sure that it s not fear that will grow from making the idea of death more conscious It s all very well to say the seed will grow, but what is the species of the plant What if we achieve only thorns in the mind, not sheltering fronds For example, Eskimo shamans of a certain tradition, through physical and mental ordeals, hone the ability to see themselves as skeletons35 This practice may seem terrifying Yet we know that such people are revered within their societies as evolved beings, able to help others.

The enterprise may want to receive full or partial Internet routes so it can pick the best exit to a particular destination, and so the provider has the best entrance to addresses in the enterprise domain BGP is necessary to get this amount of routing information To run BGP with a service provider, an enterprise needs an AS number Historically, AS numbers have been available, but, given they are a 16-bit value, they are not an infinite resource There is, however, a range of private AS numbers (64512 to 65535) that is intended not to appear on the Internet, just as private address space is intended not to appear on the Internet The problem is that the enterprise needs an AS number to run BGP, but, since they only connect to a single provider, their routing policy is dictated by the provider.

Under the criteria of RFC 1930, they do not qualify for an AS number There are, however, workarounds that do not waste a registered AS number The first case, defined by RFC 1998, deals with the case where the multihomed enterprise uses address space assigned to it by its provider The second case, defined by RFC 2270, deals with the case where the enterprise has provider-independent address space but is still multihomed to a single provider..

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